Emergency medical services

Emergency medical services have become a method relied upon for timely transportation and treatment of the injured during the twentieth century, but the modern rescue squad did not become a reality until shortly before this time. The idea of a specially trained group of people who could initiate immediate treatment to the wounded and deliver them to safety originated during Napoleon's rule, when his surgeon Dominique Jean Larrey, directed the Grand Armee todevelop mobile field hospitals, or ambulances volantes (flying ambulances), in addition to a corps of trained and equipped soldiers to aid those on the battlefield. Before Larrey's initiative in the 1790s, wounded soldiers were either left amid the fighting until the combat ended or their comrades would carry them to the rear lines. The Battle of Solferino in 1859, which wounded andkilled 40,000 French, Italian, and Austrian soldiers, led Swiss businessmanJean Henri Dunant who witnessed the massacre to coordinate a group ofcivilians to deliver aid to wounded soldiers. Dunant would forever be known for the creation of the International Red Cross, and this group would in turn instigate the training of lay people in the techniques of first aid. With inspiration from the French military, the American Civil War prompted a system of railroad ambulance cars and base hospitals that were created duringthe conflict, but these existed only on the Union side of combat.

Following the Civil War, the reform of medical care delivery and the creationof civilian ambulance service throughout the United States began to take precedence. With the northern states leading the way, Cincinnati's (Ohio) Commercial Hospital established what has been documented as the first regular ambulance operation in the country in 1865. Soon after, New York City, with direction from physician Edward B. Dalton, developed an alliance between public agencies and hospitals and private hospitals in Manhattan to create a system that divided the city into ambulance zones, with each hospital held responsiblefor its zone. Most large cities would begin organizing some type of ambulanceservice before World War I. In 1899, Chicago used the first motorized ambulance and St. Vincent's Hospital in New York City introduced electric vehiclesa year later.

The concept of emergency medical services was organized further by Julian Stanley Wise, who in 1928 formed the Roanoke Life Saving and First Aid Crew consisting of 10 trained volunteers who delivered emergency care to those in need. His foresight became the model that helped organize squads of volunteers that provide ambulance and rescue service throughout much of the United States.Historically, civilian volunteers have been looked to for emergency care, with the oldest continuously active group being the Misericordia di Firenze. Founded in 1240 A.D., this group aided the sick and transportedthe dead of medieval Florence, and hundreds of branches have remained activein northern Italy throughout the twentieth century. Keeping with Wise's ideathat the standard of all emergency work is speed, the Roanoke squad promptednational attention in the volunteer rescue movement as they reached the sceneof a drowning 16-year-old boy in 11 minutes, and effectively revived him. Twenty-six thousand members of emergency medical care teams were participatingin 850 squads around the world by 1956.

Although interest in the formation of emergency medical care began to surface, the changes came slowly during the first 65 years of the twentieth century.Transportation before the automobile consisted of horse-drawn wagons, then many communities looked to undertakers and their hearses as the main service for carrying patients. By the early 1960s, undertakers still dominated half ofthe United States ambulance service, and in many places including large cities, ambulances provided only a driver, leaving the patient to ride alone in the back. During this time, fewer than half of the 200,000 ambulance and rescue personnel were trained to the level of Red Cross advanced first aid. Education for this career was limited, with only six states offering standard courses for rescuers, and only four regulated ambulances. Opposition from physicians and the medical establishment that was determined to prevent laypeople from practicing medicine without a license stunted proper development of guidelines for rescue workers this led to their motto of "Load and go," leaving proper medical treatment waiting at the doors of the hospital.

The modern convenience of increased automobiles on the highways during the late '60s and early '70s, and the escalated number of motor-vehicle deaths thatresulted from their existence led to John F. Kennedy's label of "the greatest of the nation's public health problems," with his words forever changing the future of emergency medical services in the United States. A seminal reportin 1966 from the National Academy of Sciences catalogued the inadequacies ofthe country's emergency medical care and encouraged solutions in terms of training and standards for the service. This led to the Highway Safety Act of 1966 which set federal standards for training, equipment, and procedures for all states to comply with, leading to the organization of emergency services that was subsidized with government funding throughout the 1970s. As the 911 telephone system came into use and ambulances acquired proper communication equipment, information regarding the patient reached the hospital more efficiently, and adequate care en route became a priority.

Staffing ambulances with highly trained emergency medical technicians took precedence, and a comprehensive 81-hour course was established by the NationalHighway Traffic Safety Administration by the end of the 1960s to ensure this.The first 200 people to be trained to a national standard occurred in 1969.Another major modification to the EMS system in the United States came from aphysician in Belfast, Northern Ireland. J. Frank Pantridge, head of the cardiology department of the Royal Victoria Hospital, converted an ambulance intoa mobile cardiac-care unit with modern resuscitation techniques, medications, and an electric defibrillator he powered from two car batteries. Pantridge's idea saved countless lives, and as the United States began training their emergency medical technicians with techniques that included interpreting electrocardiograms and establishing intravenous lines, the title of paramedic became formally recognized as an essential part of a rescue squad. Their presencehas attributed to a 40% decrease in mortality from coronary artery disease in the United States since the 1960s.

Additional advances in emergency medical services throughout the twentieth century include: the Jaws of Life, a machine that generates five tons of forceto remove drivers from the tangled metal resulting from a car accident; automated defibrillation; and air transport of patients by helicopter, an idea that originated from the Vietnam War and became useful to civilians in the 1980s.

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